OB/GYN
A 25-year-old breastfeeding mother presented with right breast pain for 24-hours.
Examination confirmed a tender swelling with skin redness in the outer lower quadrant of the right breast, with warm skin, but no fluctuation. Which of the following is the most appropriate initial management?
Explanation
Core Concept: Acute lactational mastitis.
Clinical Presentation:
- Unilateral breast erythema, warmth, tenderness, swelling, and fever in a breastfeeding woman.
- Complication: Breast abscess (presents as a fluctuant mass).
Diagnosis:
- First-line: Clinical diagnosis based on signs of localized inflammation and systemic symptoms.
- Gold standard: Breast ultrasound if an abscess is suspected to differentiate from simple mastitis.
Management:
- Acute: Continue breastfeeding/pumping to empty the breast, apply warm compresses, use NSAIDs for pain, and start oral antibiotics covering Staphylococcus aureus (e.g., Flucloxacillin, Dicloxacillin, or Cephalexin).
- Long-term: If an abscess forms (fluctuance), management requires needle aspiration or incision and drainage.